Are colon polyps incidental in the presence of Helicobacter pylori?A retrospective histopathological evaluation of colon polyps in patients with concomitant colon polyps and Helicobacter pylori infection

Aim: Helicobacter pylori (H. pylori) is a bacterium that induces inflammation in the gastric mucosa and is consequently associated with gastric diseases such as peptic ulcer, gastritis, and gastric cancer. It has been classified as a Type 1 carcinogen. Although it primarily affects the stomach, several studies have suggested that H. pylori may also exert effects on other parts of the gastrointestinal tract; however, consensus on this issue has not yet been established. Some studies have reported a correlation between H. pylori infection and the occurrence of colonic polyps or colorectal cancer, while others have found no such association. In this study, we investigated whether Helicobacter pylori has an influence on colonic polyp formation in patients who underwent concurrent gastroscopy and colonoscopy, had gastric biopsies taken, were evaluated for H. pylori using pathology laboratory methods, and were found to have colonic polyps during colonoscopy for which polypectomy was performed. Materials and methods: In this retrospective study, approximately 3,500 patients who underwent both gastroscopy and colonoscopy between 2022 and 2025 in the Endoscopy Unit of Mengücek Gazi Training and Research Hospital, Department of General Surgery, were reviewed. Among them, patients who had gastric biopsies taken during gastroscopy for histopathological evaluation of H. pylori, and who were simultaneously found to have colonic polyps removed by polypectomy during colonoscopy, were included in the study. Patients with lesions, malignancy, or malignant-appearing findings other than polyps during gastroscopy or colonoscopy, as well as those without colonic polyps, were excluded. A total of 102 patients met the inclusion criteria. Of these, 63 were female and 39 were male. The youngest patient was 31 years old, the oldest was 83, and the mean age was calculated as 52 years.Polyps were categorized according to their location, size, and type, as well as by gastric H. pylori positivity or negativity. H. pylori-positive patients were further classified according to the Sydney system as negative, mild (+) 1+, moderate (++) 2+, or severe (+++) 3+. Statistical analysis was performed using SPSS 23.0 (Statistical Package for the Social Sciences, Chicago, IL, USA). The Kolmogorov–Smirnov test was used to assess the normality of data distribution. Intergroup comparisons were performed using the nonparametric Kruskal– Wallis test. Categorical variables were evaluated using the Chi-square test. Polyp size ratios were calculated using the maximum likelihood estimation method with 95% confidence intervals. A p-value less than 0.05 was considered statistically significant. Results: The likelihood of detecting colonic polyps was found to be significantly higher in H. pylori-positive patients compared to H. pylori-negative patients (p = 0.000). A highly significant relationship was also found between the severity of H. pylori infection and the 4 localization of colonic polyps (p < 0.0001). In patients with H. pylori positivity graded as +1 or +2, polyps were most frequently observed in the rectum, whereas in those graded as +3, polyps were most commonly located in the descending colon. When all polyps were evaluated collectively, they were most frequently located in the rectum and sigmoid colon. Similarly, when H. pylori-positive and -negative patients were analyzed separately, rectal and sigmoid colon localizations remained the most common, consistent with findings reported in the literature. Conclusion: Statistical analysis indicated that gastric H. pylori infection may play a role in the development of colonic polyps. A significant correlation was also observed between H. pylori positivity and the localization of colonic polyps. Based on these findings, it may be beneficial to include H. pylori-positive patients in colon polyp screening programs. Furthermore, since H. pylori infection may not be confined to the stomach, performing simultaneous gastroscopy and colonoscopy in H. pylori-positive patients could provide clinical advantages. Nevertheless, further large-scale studies are required to substantiate these findings.